Feasibility and preliminary efficacy of iConquerFear: a self-guided digital intervention for fear of cancer recurrence

Abstract

Purpose Approximately 50% of cancer survivors experience moderate-severe fear of cancer recurrence (FCR). Self-guided digital interventions have potential to address the high level of FCR-related unmet needs at scale, but existing digital interventions have demonstrated variable engagement and efficacy. This study aimed to evaluate the feasibility and preliminary efficacy of iConquerFear, a five-module self-guided digital FCR intervention. Methods Eligible curatively treated breast cancer survivors were recruited. Participants reporting clinically significant FCR (≥ 13 on the Fear of Cancer Recurrence Inventory-Short Form; FCRI-SF) were given access to iConquerFear. Feasibility was indicated by > 50% of eligible participants enrolling in iConquerFear and recording moderate (≥ 120 min) or greater usage. Preliminary efficacy was evaluated via changes in self-reported FCR severity, anxiety, depression, intrusions and metacognitions from baseline to immediately and 3 months post-intervention. Results Fifty-four (83%) of 65 eligible participants enrolled in iConquerFear; six subsequently withdrew. Thirty-nine (83%) participants recorded moderate (n = 24; 120–599 min) or high (n = 15; ≥ 600 min) usage. Engagement levels increased with participant age (p = 0.043), but were lower in participants with higher baseline FCR (p = 0.028). Qualitative feedback indicated engagement was sometimes limited by difficulties with navigation and relating to featured survivors. Participants reported significantly improved FCR (mean reduction (95%CI): baseline to post-intervention − 3.44 (− 5.18, − 1.71), baseline to 3-month follow-up − 4.52 (− 6.25, − 2.78), p = < 0.001). Conclusion iConquerFear is a feasible and potentially efficacious intervention for reducing FCR in breast cancer survivors. Easier navigation and more relatable examples may enhance engagement. Implications for Cancer Survivors iConquerFear may help address moderate but burdensome FCR levels in cancer survivors.

Is digital intervention for fear of cancer recurrence beneficial to cancer patients?: A systematic review and meta‐analysis

“…In our research, the traditional CBT study 32 56 recent studies suggest that older adults also may benefit from it. An overview 57 suggested that a combination of face-to-face and digital services could be valuable to the elderly.…”

“…An overview 57 suggested that a combination of face‐to‐face and digital services could be valuable to the elderly. A recent study has shown that older adults participate more in digital interventions to reduce FCR 56 . These results suggest that older people's digital literacy may have improved over the past decade or so 56 .…”

“…Therefore, cautious interpretation is needed regarding whether digital interventions in FCR would be effective in elderly patients with cancer. While it had been known that younger people may adapt better to digital interventions, 56 recent studies suggest that older adults also may benefit from it. An overview 57 suggested that a combination of face‐to‐face and digital services could be valuable to the elderly.…”

“…56 These results suggest that older people's digital literacy may have improved over the past decade or so. 56 One study suggested that older cancer patients located far from a cancer center can utilize the Internet to improve services and support, locate the information they need, and mobilize their families. 58 Given these recent findings, older adults are expected to benefit from digital FCR interventions.…”

Digital therapeutics in the clinic

“…Within the oncology‐focused trials, DTx were tailored to be centered on patient support in the cancer recovery process within breast cancer and generalized cancers (Figure 3b); these DTx focus on maintaining social networks for the patient during the treatment process in addition to addressing cancer‐related anxiety 74 and lifestyle tracking 75 . These approaches often address orthogonal psychiatric issues related to the cancer itself such as depression 76 .…”